Access to HCV treatment in Europe

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1 Access to HCV treatment in Europe 11 December 2015 EHHC, London Svilen Konov, European AIDS Treatment Group (EATG)

2 Mr Svilen Konov European AIDS Treatment Group (EATG) Speaker Name Svilen Konov COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Statement None declared Date 3 Dec 2015

3 In this presentation Community based research Some results How community sees access How some models work or do they really? Several musings

4 Community based research-eatg Methodology: CBOs and where no CBOs registered, individuals contacted. Data had to be confirmed by an official source Questionnaire with 10 questions in English and Russian

5 Community based research-eatg

6 Some results-34 countries Albania, Armenia, Austria, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Belarus, Switzerland, Germany, Spain, France, UK, Georgia, Greece, Croatia, Hungary, Italy, Lithuania, Latvia, Moldova, Macedonia, Netherlands, Portugal, Romania, Serbia, Sweden, Turkey, Ukraine, Russia, Kyrgyzstan, Kazakhstan, Tajikistan, Turkmenistan, Uzbekistan

7 Some results 12 countries out of the 34 do not have access to any DAAs (i.e. Macedonia, Serbia) 18 countries report registered DAAs, but no availability/option to use some of them in clinical practice (mainly countries from the east EU, Armenia) Interestingly, only 6 countries say that one can buy DAAs privately (i.e. Hungary, some countries from Central Asia) All countries have medical requirements for access; where 7 allow/in discussion about F2, while the rest F3-F4 From larger countries France, Portugal, Russia, Ukraine* give priority to co-infection

8 How community sees the road to access Increase knowledge/sensitise society Epidemiology Physical access to treatments Prices of treatment Optimisation of guidelines Clinical programmes Emphasis on particular sub-populations Relevant research

9 Increase knowledge/sensitise society In Bulgaria, they tested all participants of celebrity Big Brother in real time, prime time.

10 Epidemiology Prices of testing Gaps and lacks of unified surveillance systems (i.e. The Netherlands-no registry for HCV mono-infection, Germany-estimations, UKestimations)

11 Physical access to treatments Registration does not mean access Once registered, the medicine needs to be included in the list of the life-important medicines Once included, it needs a price registration and a tender Then, it is centrally (maybe totally decentralised in some countries) distributed to the clinics

12 Prices Spain: With regard to drug pricing, there are two prices, namely the list price of EUR 40,000 per patient treated (irrespective of the treatment duration), and then there is a price for the reimbursement system which is not public. The price should fall alongside with the increase in the number of patients. As an example, with 50,000 patients, it should fall to approximately EUR per cure.

13 Prices The Netherlands: Sovaldi 14,280 Euros/tablet 400 mg (28). Olysio 2, Euros/capsule 150 mg (7), Daklinza 314,58 Euros/tablet 60 mg Switzerland: Sovaldi 400 mg (28) 18, Euros, Olysio 150 mg (7) 2, Euros, Harvoni (28) 19, Euros

14 Prices of treatments

15 Optimisation of guidelines/national plans National plans EACS EASL Work with Russia

16 Clinical care, sub-populations, relevant research Who provides me with care? Specialist vs. primary care physician; where do I get the care? How about the drug-users, inmates, people with advanced cirrhosis, pre- and posttransplant, GT3 Cross-company collaborations

17 How some models work or do they Всем здравствуйте, really? Уже более месяца в Узбекистане можно купить генерический софосбувир в аптеках. Мало кто об этом знает. Стоимость: сум за упаковку. Сейчас это составляет около 250$ Телефон одной из аптек, продающих софосбувир в Ташкенте: XXX XX XX С уважением, XXXXXX XXXXX

18 Some musings Evolution vs. devolution

19 Thank you!

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